| NPI | 1437572450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOCELYN TELLO Owner 360-931-0605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WA PY00003900) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2014-01-27 |